EENT 9% Flashcards
Eyelid changes: crusting, greasy, scaling, red-rimming of eyelid and eyelash, flaking along with dry eyes and associated seborrhea and rosacea
Blepharitis
History of blunt trauma, muscle entrapment, eyelid swelling, gaze restriction, double vision, decreased visual acuity, enophthalmos (sunken eye).
Blowout fracture
Blowout fracture: anesthesia/paresthesia in the gums, upper lips, and cheek due to damage to the ______ nerve
infraorbital
Blurred vision over months or years, halos around lights.
Cataract
Clouding of the lens =
Clouding of cornea =
Cataract; glaucoma
Cataract treatment
Fundoscopy: “black on red background.”
A sterile painless (non-infectious) granuloma of the internal meibomian sebaceous gland, painless “cold” lid nodule
Chalazion
Copious watery discharge, scant mucoid discharge.
Viral conjunctivitis
Adenovirus (most common). Self-limiting associated with URI.
Pt presents with purulent (yellow) discharge, crusting, usually worse in the morning. May be unilateral.
Bacterial conjunctivitis
Acute mucopurulent conjunctivitis
S. pneumonia, S. aureus
Copious purulent discharge, in a patient who is not responding to conventional conjunctivitis treatment
M. catarrhalis, Gonococcal
Conjunctivitis in newborn; scant mucopurulent discharge; giemsa stain - inclusion body.
Chlamydia
Red eyes, itching and tearing, usually bilateral, cobblestone mucosa on the inner/upper eyelid.
Allergic conjunctivitis
Sudden onset of eye pain, photophobia, tearing, foreign body sensation, blurring of vision, and/or conjunctival injection.
Corneal abrasion
Corneal abrasion diagnosis; treatment
Fluorescein dye - increased absorption in devoid area.
Antibiotic eye ointment, no patching.
Contact lense wearers; caused by deep infection in the cornea by bacteria, viruses or fungi.
Corneal ulcer
Corneal ulcer findings; testing
White spot on surface of cornea that stains with fluorescein: round “ulceration” versus “dendritic” pattern like herpes
Inflammation of the nasolacrimal duct or the nasolacrimal gland (supratemporal);
Infectious obstruction of nasolacrimal duct (inferomedial region)
Dacryoadenitis
Dacryocystitis
Eversion of the eyelid; occurs when the eyelid turns outward exposing the palpebral conjunctiva; conjunctiva will appear red from air exposure and inflammation
Ectropion
Inversion of an eyelid; occurs when the eyelid turns inward; cause; treatment.
Entropion.
Most commonly caused by age-related tissue relaxation. Surgical correction is definitive
Ocular foreign body treatment; possible sequella
Irrigation and removal with sterile swab.
Intraocular foreign bodies require immediate surgical removal by an ophthalmologist.
Metallic foreign bodies may leave a rust ring.
Ocular aqueous outflow obstruction, most common, > 40 y/o, African Americans, often asymptomatic, peripheral to central gradual visual loss (versus macular degeneration which is central loss)
Open angle glaucoma
Acute angle closure glaucoma signs/symptoms
Iris against lens, dark environment, acute loss of vision, nausea, and vomiting. Classic triad: injected conjunctiva, steamy cornea, and fixed dilated pupil; this is an ophthalmic emergency.
Painful, warm (hot), swollen red lump on the eyelid (different from a chalazion which is painless); cause
Hordeolum
Think “H” for Hot = Hordeolum.
Most common organism S. aureus.
Trauma causes blood in the anterior chamber of the eye (between the cornea and the iris). The blood may cover part or all of the iris (the colored part of the eye) and the pupil, and may partly or totally block vision in that eye.
Hyphema
Hyphema treatment
Treat with eye protection and rest with the head of the bed at 30 degrees all the time.
Gradual painless loss of central vision. The macula is responsible for central visual acuity which is why macular degeneration causes gradual central field loss. Metamorphopsia (distortion on Amsler grid)
Macular degeneration
Atrophic changes with age – slow gradual breakdown of the macula (macular atrophy), with Drusen (yellow retinal deposits).
Dry macular degeneration (85% of cases)
Drusen = Dry
Hemorrhage, neovascuration. New abnormal vessels grow under central retina which leak and bleed causing retinal scarring.
Wet macular degeneration
Rapid involuntary eye movement
Nystagmus
Most common and often benign nystagmus
Gaze-evoked
Down/upbeat nystagmus etiology
CNS dysfunction
Vestibular (horizontal) nystagmus etiology
Labyrinth or vestibular nerve dysfunction
Acute inflammation and demyelination of the optic nerve leading to acute monocular vision loss/blurriness and pain on extraocular movements. Typically occurs over hours or days. Associated with multiple sclerosis.
Optic neuritis
Optic neuritis fundoscopy findings
Inflammation of the optic disc
Decreased extraocular movement, pain with movement of the eye and proptosis, signs of infection. Often associated with sinusitis. Occurs more often in children than adults.
Orbital cellulitis
Orbital cellulitis treatment
Hospitalization and IV broad-spectrum antibiotics.
Optic disc swelling that is caused by increased intracranial pressure. The swelling is usually bilateral and can occur over a period of hours to weeks.
Papilledema
Papilledema causes
Brain tumor/abscess, meningitis, cerebral hemorrhage, encephalitis, pseudotumor cerebri.
Papilledema testing; treatment
Immediate neuroimaging to rule out mass lesion, then
CSF analysis.
Treat underlying cause.
Elevated, superficial, fleshy, triangular-shaped “growing” fibrovascular mass (most common in inner corner/nasal side of the eye). Treatment.
Pterygium
Only surgically remove when vision is affected
Vertical curtain coming down across the field of vision, may sense floaters or flashes at onset, loss of vision over several hours. Asymmetric red reflex.
Retinal detachment
Retinal detachment treatment
Consult ophthalmologist. Stay supine (lying face upward) with head turned towards the side of the detached retina.
Sudden, painless, unilateral, and usually severe vision loss (Amaurosis fugax).
Retinal vascular occlusion
Retinal vascular occlusion etiologies
Embolism from the same side (ipsilateral) carotid artery, ophthalmic artery, or heart, or giant cell arteritis.
Retinal vascular occlusion testing
Rule out carotid artery stenosis by carotid ultrasound. Look for the cherry red spot.
Retinopathy
Leading cause of blindness, most common is diabetic retinopathy. Proliferative type is most severe.
Retinopathy funduscopic exam
Cotton wool spots, hard exudates, blot and dot hemorrhages, neovascularization, flame hemorrhages, A/V nicking
Any form of ocular misalignment
Strabismus
Strabismus test
Cover/uncover test
Exotropia; esotropia
Out-turning of eyes; in-turning of eyes.
Strabismus treatment
Patch exercises, if untreated after age two, amblyopia results.
Acute/chronic otitis media findings
Age 2 and under, limited mobility of the TM with pneumotoscopy.
Acute/chronic otitis media organisms
S. pneumoniae 25%, H. influenzae 20%, M. catarrhalis 10%
Acute/chronic otitis media treatment
First line Amoxicillin.
Second line Augmentin; macrolides if pen allergic
Acute/chronic otitis media complications
Mastoiditis and bullous myringitis.
Benign tumor of the Schwann cells (the cells which produce myelin sheath) – most commonly affects the vestibular division of the 8’th cranial nerve.
Acoustic neuroma
Acoustic neuroma symptoms
Slowly progressive unilateral hearing loss, tinnitus, disequilibrium.
Acoustic neuroma diagnosis and treatment
Diagnose with MRI.
Treat with surgery or stereotactic radiation therapy
Barotrauma presentation
Ear pain and hearing loss that persists past the inciting event, associated with pressure changes.
Common injury in divers or while flying; sudden onset of pain that may resolve with a “pop.”
Cholesteatoma
Painless otorrhea, brown/yellow discharge with strong odor, caused by chronic eustachian tube dysfunction which results in chronic negative pressure and inverts part of the TM causing granulation tissue that over time, erodes the ossicles and leads to conductive hearing loss. Surgical removal.
Ear fullness, popping of ears, underwater feeling, intermittent sharp ear pain, fluctuating conductive hearing loss, tinnitus.
Eustachian tube dysfunction.
All children < 7 years old have some ET dysfunction (based on the angle of the ET); will resolve with age
Foreign body in ear treatment
Insects must be immobilized prior to removal. Drown insects with mineral oil or viscous lidocaine before attempting removal. After irrigation, if the child is uncomfortable, consider treating with topical pain agents such as benzocaine-antipyrine
Most common causes of hearing impairment/loss
Cerumen impaction, eustachian tube dysfunction (secondary to upper respiratory tract infection [URI]), and increasing age (presbycusis)
Hearing impairment Weber test
Tuning fork is placed on center of the head and see if sound lateralizes: Sound lateralizes to affected ear in conductive hearing loss; sound lateralizes to unaffected ear in sensorineural hearing loss
Hearing impairment Rinne test
Tuning fork placed on mastoid and then up to the ear (should continue to hear) conductive hearing loss if bone > air, sensorineural hearing loss if air > bone
Blunt trauma to ear shearing forces to the anterior auricle lead to separation of the anterior auricle perichondrium from the underlying cartilage. May result in thickening of cartilage (cauliflower ear) if not treated promptly! .
Hematoma of the external ear.
Evacuate blood and cephalexin
Acute onset, vertigo + hearing loss, tinnitus of several days to a week. Usually viral, absence of neurologic deficits.
Labyrinthitis
Labyrinthitis etiology
Usually viral
Labyrinthitis treatment
Diazepam or meclizine for vertigo, promethazine for nausea
Complication of acute otitis media. Fever, otalgia, pain & erythema posterior to the ear, and forward displacement of the external ear.
Mastoiditis
Mastoiditis organisms
S. pneumoniae, H. influenzae, M. catarrhalis, S. aureus, S. pyogenes.
Mastoiditis treatment
IV antibiotics (ceftriaxone), drainage of middle ear fluid.
Vertigo attacks lasting hours.
Classic triad of low-frequency hearing loss, tinnitus with aural (ear) fullness and vertigo
Meniere’s disease
Meniere’s disease treatment
Low salt diet, diuretics (HCTZ + triamterene) to reduce aural pressure
Otitis externa presentation
Edema with cheesy white discharge, palpation of the tragus is painful
Otitis externa organisms
Pseudomonas aeruginosa (swimmer’s ear), S. aureus (digital trauma)
Malignant otitis externa is commonly seen in _______
Diabetics
Tinnitus
Perceived sensation of sound in the absence of an external acoustic stimulus; often described as a ringing, hissing, buzzing, or whooshing.
Tinnitus etiologies
90% is associated with sensorineural hearing loss – caused by loud noise, presbycusis, medications (aspirin, antibiotics, aminoglycosides, loop diuretics and CCBs), Meniere’s disease, acoustic neuroma.
Tympanic membrane perforation sign/symptoms
Pain, otorrhea, and hearing loss/reduction
Tympanic membrane perforation treatment
Keep clean and dry, treat with antibiotics - the only class of antibiotics that are non-ototoxic are Floxin drops. Surgery if persists past 2 months.
Central vertigo
More gradual onset and vertical nystagmus. Unlike peripheral vertigo, it does not present with auditory symptoms. Romberg Sign.
Central vertigo etiologies
Brainstem vascular disease, arteriovenous malformations, tumors, multiple sclerosis, and vertebrobasilar migraine.
Peripheral vertigo (inner ear)
Sudden onset, nausea/vomiting, tinnitus, hearing loss, and horizontal nystagmus.
Peripheral vertigo (inner ear) etiologies
Labyrinthitis, benign paroxysmal positional vertigo, endolymphatic hydrops (Ménière’s syndrome), vestibular neuritis, and head injury.
Benign Positional Vertigo diagnosis/treatment
Dix-Hallpike maneuver; Epley’s maneuver
Sinus pain/pressure (worse with bending down and leaning forward). After URI. Facial tap elicits pain.
Acute and chronic sinusitis
Sinusitis, viral, symptoms
Most common, symptoms < 7 days
Sinusitis, bacterial, symptoms
Symptoms 7+ days and associated with bilateral purulent nasal discharge.
Sinusitis, bacterial, organisms
S. pneumoniae, H. influenzae, M.catarhalis.
Sinusitis treatment
Indications for antibiotics in rhinosinusitis include duration of symptoms >10 days without improvement, Augmentin 875 BID, kids Amoxicillin x 10-14 days.
Chronic sinusitis testing
Plainview X-ray (waters view) is a good initial screening, CT is the gold standard.
Allergic rhinitis
Clear nasal drainage, pruritus, pale, bluish, boggy mucosa, allergic shiners, IgE mediated mast cell histamine release
Allergic rhinitis treatment
Intranasal decongestants not to be used more than 3-5 days; may cause rhinitis medicamentosa
Epistaxis anterior source
Kiesselbach’s Plexus or Little’s Area is the most common site
Epistaxis posterior source
Shenopalatine artery (Woodruff’s plexus) is generally the source of severe posterior nosebleed
Epistaxis treatment
Direct pressure for 15 minutes, posterior balloon packing is used to treat posterior epistaxis
Purulent, foul-smelling nasal discharge
Nasal foreign body
Teardrop-shaped growths that form in the nose or sinuses, usually benign, associated with allergic rhinitis.
Nasal polyps
Samter’s triad
Aspirin sensitivity, Asthma, and nasal polyps.
When multiple polyps are seen, consider _______
Cystic Fibrosis
Acute pharyngitis etiologies
Viral - Adenovirus (most common), mononucleosis, Group A Streptococcus, Neisseria gonorrhea, fungal
Mononucleosis etiology, sign/symptoms, testing
Epstein Barr virus, fever, sore throat, lymphadenopathy, splenomegaly, atypical lymphocytes, + heterophile agglutination test (monospot).
Mononucleosis precautions
Symptomatic and avoid contact sports. Antibiotics such as amoxicillin or ampicillin may cause a rash.
In patients with recent sexual encounters, or with non-resolving pharyngitis consider _________
Gonorrhea pharyngitis
Acute pharyngitis in patients using inhaled steroids consider _________
Fungal causes
Centor Criteria; increased likelihood of _________
Absence of cough, exudates, fever, cervical lymphadenopathy.
Group A Streptococcal pharyngitis: S. pyogenes.
Acute pharyngitis testing
Throat culture is gold standard
Strep pharyngitis treatment
Penicillin is first line, Azithromycin if Pen allergic.
Strep pharyngitis complications
Rheumatic fever and post-strep glomerulonephritis.
Aphthous ulcers
Single or multiple small, shallow ulcers with yellow-gray fibrinoid center with red halos
Aphthous ulcer testing
Biopsy should be considered for ulcers lasting more than 3 weeks
Aphthous ulcer treatment
Viscous lidocaine 2–5% applied to ulcer QID after meals until healed
Gingivitis risk
Increases risk for cardiovascular events
Gingival hyperplasia; etiologies
Overgrowing of gums so that it blocks the teeth, commonly caused by medications. phenytoin, CCB’s and cyclosporine
Vincent’s angina
“Trench Mouth” - necrotizing gingivitis: characterized by the “punched-out” ulcerative appearance of the gingival papillae
Dental abscess etiology; risk; treatment
Poor dental health is a risk factor for dental abscess or facial cellulitis, treat with IM ceftriaxone and amoxicillin
Unvaccinated patient leaning forward, drooling, stridor and distress (tripod position, muffled voice)
Epiglottitis
Epiglottitis etiology
H. influenza type B (Hib)
Epiglottitis diagnosis; treatment
Lateral radiograph: Thumbprint sign.
Secure airway, IV Ceftriaxone, and IV fluids.
Laryngitis
Almost always viral, hoarseness following a URI
Laryngitis > 2 weeks, history of ETOH and/or smoking, consider _________
Squamous cell carcinoma
Laryngitis symptoms persisting > 3 weeks, then _____
laryngoscopy
Oral Candidiasis presentation
Immunocompromised, young patients. Painful, white fluffy patches that can be scraped off and may bleed when scraped (candidiasis can “come off”), leaving an erythematous, friable base.
Oral candidiasis test
Diagnose with potassium hydroxide (KOH) prep
Oral herpes simplex presentation
Prodromal period of tingling discomfort or itching, vesicular lesions all in the same stage of development, HSV type 1
Painless, precancerous white lesions on the side of the tongue that cannot be scraped off
Oral leukoplakia
Oral leukoplakia predispositions
Smokers, AIDs, alcohol abuse
Hot potato (muffled) voice and deviation of the uvula to one side
Peritonsillar abscess
Parotitis; etiology; in adult males consider associated _______
Mumps; Paramyxovirus; orchitis
Acute swelling of the cheek, which worsens with meals.
Sialadenitis [think salad = salivary]
Sialadenitis etiology
Infection of a salivary gland (S. aureus) usually caused by sialolithiasis (obstructing stone) in the salivary gland.
Sialadenitis diagnosis
CT, ultrasonography, or MRI
Thyroid neoplastic disease, most common type
Papillary. See endocrinology.
Oral Cancer: Most often ______ secondary to the use of __________ and account for up to ___ percent of cases of _______ of the head and neck
Squamous cell carcinoma; tobacco and alcohol; 80; squamous cell carcinoma
Cyst appearing after URI anterior to sternocleidomastoid; most common lateral neck mass
Branchial cleft cyst
Hyoid or sub-hyoid soft mass which rise with tongue protrusion; most common midline neck mass
Thyroglossal duct cyst
Unilateral, painless, persistent cervical lymphadenopathy consider _____
lymphoma; see hematology
White oral lesion that is painless and cannot be rubbed or scraped off. Often linked with tobacco, alcohol, or denture use.
Leukoplakia
Leukoplakia: 5% are ____________
Dysplastic or squamous cell carcinomas
